Job Specification Details

Analytic, research, evaluation, and advisory work at a professional level involving the review, analysis and evaluation of the All-Payer Model/Accountable Care Organization (APM/ACO) and Budgets for Vermont’s 14 Hospital budgets.  Issues involved are frequently of a sensitive, even controversial, nature. Extensive contact occurs with officials of ACO, Vermont’s Hospitals, federal Center for Medicare & Medicaid Innovation, Green Mountain Care Board (GMCB), and other departments. Duties are performed under the general direction of the Director of Health System Finances. This position operates within general guidelines related to ACO and Hospital Budget Review with independence.  Analysis and review of annual ACO budget submission: In 2019, the ACO budget totals nearly $900 million in health care costs for approximately 172,000 Vermonters. The ACO has participation in 2019 from 12 of Vermont's 14 community hospitals, 132 primary care practices, 242 specialty care practices, 6 Federally Qualified Health Centers and 23 skilled nursing facilities.  Analysis and review of annual budget submissions for Vermont's 14 community hospitals: For fiscal year 2019, Vermont's 14 community hospitals submitted budgets totaled more than $2.2 billion in net patient revenue.

• This position requires considerable knowledge of accounting principles, federal and state government organizational and administrative procedures, management principles and practices, public budgetary principles, organizational design, economic theory and practice - especially as these areas of knowledge relate to revenue and demand for health care services.
• It requires complex analytic and problem-solving skills, the ability to make decisions and recommendations independently, and the ability to defend those decisions and recommendations. Making recommendations may be difficult due to competing interests and non-negotiable requirements (e.g., federal government regulations).
• In addition to technical and decision-making skills, the position requires excellent communication skills and the ability to negotiate diplomatically and effectively with other team members, GMCB leadership and board members as well as external parties, in order to achieve best practices in reporting and monitoring. The role involves intensive interaction with officials who may advocate strongly for their organizations and/or point of view. 
• The position is responsible for leading annual review of Accountable Care Organization (ACO) financial goals, needs, resources, plans, and budget submissions. Tasks related to the review include analysis, research (including research on national accounting standards related to this cutting-edge payment reform), evaluation, and advisory work at a professional level. The position presents regular testimony related to ACO finances at public meetings of the GMCB.
• This staff member serves as the finance expert on the GMCB's cross-functional ACO regulatory team consisting of policy and legal staff in addition to finance staff.
• The person is a key member of the team that provides financial analysis and technical assistance in reviewing detailed budget and actual financial information submitted by Vermont's 14 hospitals to the GMCB.  This includes preparing written summaries and presentations related to hospital budget submissions and reports of actual financial results including variance from approved budget, for the GMCB and for testimony and other public presentations.
• This position performs the financial review on all certificates of need and provides a memo and any questions to the Senior Health Policy Analyst to be included in the rounds of questions with the applicant.
  • New health care projects in Vermont must obtain a Certificate of Need (CON) from the Green Mountain Care Board prior to implementation.  
  • The CON process is intended to prevent unnecessary duplication of health care facilities and services, guide their establishment in order to best serve public needs, promote cost containment, and ensure the provision and equitable allocation of high-quality health care services and resources to all Vermonters. 
  • For size and scale, 2018 decisions ranged from $2 million replacement of a radiology suite to $151.7 million over six years for replacement of UVM’s electronic records and related health IT systems.  
• The position also assists with developing processes and documents supporting ACO and hospital budgetary and financial submissions. Such support may include creation of budget guidance provided annnually to the ACO and the hospitals, designing reporting modules in the GMCB's web-based financial reporting platform, and facilitating work groups established to improve processes and reporting requirements.

Duties are performed mainly in a standard office setting but with frequent need to attend and-or chair meetings in a variety of department, state, and private settings, frequently involving work outside of normal office hours. Travel is involved for which private means of transportation must be available. Short notice of critical meetings, quick deadlines for important reports, and need for rapid response to federal or legislative inquiries can be assumed.

• Considerable knowledge of federal, state, and local governmental organization and administrative procedures.
• Considerable knowledge of management principles and practices.
• Considerable knowledge of public budgetary principles and fiscal procedures.
• Considerable knowledge of organizational design, theory, and systems.
• Working knowledge of economic theory and practice, particularly as they affect revenue flow and demand for health care services.
• Considerable knowledge of information technology software and applications, particularly those related to financial analysis (e.g., Excel).
• Working knowledge of basic research methodology.
• Ability to analyze complex activities, relationships and situations, identify problems, draw logical conclusions, and develop and defend independent recommendations.
• Ability to negotiate diplomatically and effectively with leadership at the GMCB, ACO, Vermont’s 14 hospitals, Health Care Advocate and other heads and officers of agencies and programs.
• Ability to communicate orally and in writing with clarity and precision.
• Ability to establish and maintain effective working relationships.
• A high degree of innovative capability.

Associate’s degree or higher in accounting, finance, statistics, economics, business administration, or related field AND four (4) years or more of experience with accounting, budgeting, fiscal auditing or analysis, or related field that includes experience managing programs, funding sources, or staff.
OR
Six (6) years or more of experience with accounting, budgeting, fiscal auditing or analysis, or related field that includes experience managing programs, funding sources, or staff.

Master’s degree or higher in relevant field.
Experience in program planning and/or evaluation.
Experience working with regulatory boards under Vermont’s Open Meeting Law.